MEDICARE: LATIFA JANICE JALALI DEGRAFT-JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME105724	FL
2	207Q00000X	Family Medicine Physician	237874	NY

General Provider Information

NPI Number	:	1538111471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATIFA JANICE JALALI DEGRAFT-JOHNSON M.D.

Provider Business Mailing Address
First Line	:	450 W 42ND ST APT 39D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-6881
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 PARK AVE S # 76071
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-1502
Country	:	US
Telephone Number	:	646-863-1411
Fax Number	:	305-363-5044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/29/2024

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